Pleurisy

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Diagnosis

Pleurisy diagnosis involves taking a patient history (including a history of symptoms) and performing a physical examination and diagnostic tests. The patient history includes information about past or current medical conditions (e.g., heart disease), possible exposure to tuberculosis (e.g., through travel) or asbestos (e.g., in the workplace), and smoking.

The physician usually will ask the patient to describe his or her symptoms. For example:

• What does the pain feel like? Is it sharp or dull?
• Does the pain spread to the shoulder or back? Does it go away and then return?
• When did the pain start?
• What worsens or improves the pain?
• Are there any other symptoms?

During the physical exam, the physician listens to the patient's lungs with a stethoscope to detect abnormal sounds (e.g., pleural friction rub) and measures his or her blood pressure, heart rate, and temperature. Reduced breath sounds can indicate conditions that may be related to pleurisy, such as pleural effusion and pneumothorax.

Diagnostic tests (e.g., complete blood count [CBC]) often are performed to help determine the underlying cause for pleurisy. These tests may include blood tests (e.g., complete blood count [CBC], arterial blood gas), imaging tests (e.g., chest x-rays, ultrasound, CT scan), and a procedure called thoracentesis. Imaging tests can be used to determine the level of fluid or air in the pleural space and evaluate tissue surrounding the lungs for disease or trauma.

Thoracentesis (pronounced THŌR-a-sĕn-TEE-sĭs) involves using a needle to remove a sample of fluid from the pleural space and analyzing the fluid in a laboratory. This test can be used to help diagnose several conditions, including pneumonia, cancer, tuberculosis, lupus, rheumatoid arthritis, congestive heart failure, and liver or kidney diseases. Possible complications of this procedure include pneumothorax, collapsed or partially collapsed lung, excessive bleeding, infection, pain, and (rarely) injury to the liver or spleen.

If the physician suspects tuberculosis or cancer, a biopsy of the pleura may be performed. In this procedure, a small sample of tissue is removed using a needle (needle biopsy) or through a small incision in the chest wall (laparoscopic pleural biopsy or open pleural biopsy) and examined under a microscope.

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